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the removal of small portions of its rim, covered with lymph,and of a pretty healthy aspect, and he hoped that a soft sub-stance would be thrown out-between the acetabulum and theshaft, to facilitate the movements of the part after recovery.He had removed some part of the shaft, in order that noobstacle should be offered to such movements. Mr. Hawkinsfurther stated, that diseased action might nevertheless go onin the acetabulum, but the patient had certainly at present abetter chance of recovery than before the operation.

In examining the parts which had been removed, it wasfound that a great portion of the head of the bone had beendestroyed by caries; there was no actual necrosis, but thecancelli of the process had evidently undergone the changesusually effected by a slow ulcerating process. A little beemor-rhage took place after the child’s removal into the ward; butthis was easily arrested, and the progress was pretty favour-able for a couple of days. Still it would appear that the littlepatient’s strength had been so materially diminished by thelong-continued diseased state of the hip, that she could notwithstand the shock of the operation, as she died on the thirdday after it.The post-mortem examination did not reveal any facts of

importance, except as regards the state of the acetabulum.This cavity was filled, as had been stated by Mr. Hawkins,with a fibrinous mass, which occupied almost the whole areaof the acetabulum. As this product was not firmly adheringto the bone, the finger could easily be insinuated under it.By this examination, it was found that the bottom of thecavity was in a carious condition, the centre being completelyperforated, so as to allow the index-finger to impinge on thefascia lining the iliac fossa.

It is thus evident that the reparative process would herehave been of hardly any avail, and it was not without goodreason that Mr. Hawkins stated, after the operation, that thefinal result depended mainly on the state of acetabulum. Onecannot help thinking, in considering all the facts connectedwith the preceding case, that perhaps a time will come whenthis operation will be resorted to somewhat earlier in thecourse of hip-joint disease. Anchylosis is certainly a verydesirable termination, but it must remain clear that instancesmay spring up where this consolidation of parts is not likelyto take place, however long it may be waited for. Thedifficulty would, therefore, seem to lie principally in the dis-crimination of the cases which should be operated early, andthose where anchylosis may be looked forward to with areasonable prospect of favourable results.We have found, in the post-mortem records of St. Thomas’s

Hospital, two examinations, which will illustrate in a very in-structive manner the state in which the hip-joint is sometimesfound after long-continued disease.The first case is that of a girl, aged sixteen, who was ad-

mitted Oct. 22, 1850, under the care of Mr. South, with hip-joint disease of long standing. The autopsy took placeApril 8,1851. The right hip was dislocated on the dorsum ofthe ilium, and a large irregular sore existed on the inner andfront part of the joint, laying bare the body of the rightpubis, and partly that of the left. The exposed bone was in acarious state; the sore communicated with the joint, and thecellular and muscular tissues between them were blackenedand partially disorganized.On examining the joint itself, the capsular ligament was

found to be almost entirely destroyed, a small band onlyremaining at the lower part. The head of the femur wasentire, and covered by cartilage, to which here and there athin layer of false membrane adhered; but on cutting throughthe cartilage it was found to be separated from the bone,which was roughened and softened beneath it. The neck ofthe bone, as well as portions of°the trochanter major, wasdenuded and carious. The dislocated head rested merelyamong the glutsei muscles, and had formed no socket. On ex-amining the acetabulum, its lips were found to be carious, andthe cavity, which was of the natural size, was nearly filledwith an organized substance which had an almost gelatinousappearance. The cartilage was but loosely attached to the

bone, the latter being much more vascular and soft thannatural. There were several abscesses in the lungs.

In the second case the disease had likewise been existingfor a long while in the right hip-joint. On opening theabdomen, it was found that in the right lumbar region,the external surface of the ascending colon was connectedby rather recent adhesions with the peritonaeal lining of theabdominal parietes. In this situation was an irregular abscess,which opened externally, and also into the ascending colon bya small round ulcer, having smooth cicatrized edges; thisabscess communicated directly with the right hip-joint, pass-

ing across the iliac muscle, which was partially destroyed.The matter had escaped from the coxo-femoral articulation,and then passed upwards along the border of the psoas andiliacus tendons, then partly through the iliacus muscle, to alittle above the crest of the ilium.

LONDON HOSPITAL.Amaurosis probably depending on Concussion.

(Under the care of Mr. CURLING.)MR. CURLING has for the last few weeks had under his care

a youth, aged thirteen, who suffers from amaurosis of theright eye, the cause of which is rather obscure. The boy wasadmitted January 19, 1852, and it appears that about twomonths before that date, whilst walking by the side of ahedge, he received in his face a charge of shots, fired, doubtlessinadvertently, by a person on the other side.The patient was not knocked down by the blow, though he

bled much from the face, which was considerably ecchymosed.The parts around the left eye swelled immediately; the globe,however, remained uninjured, for the boy says that by raisingthe oedematous lid he could see very well. The right eyesuffered a little more, some conjunctival inflammation (as itwould seem) occurred, and some shots lodged in the maxillarybone, just below the inferior lid, where they can now be felt.But the inflammation did not run high; by simple means thepatient was pretty well in a week, with good sight on the leftside, but loss of vision on the right.When admitted for this latter symptom, the globe of the

right eye presented no abnormal appearances, except a smallclot under the conjunctiva, which clot was being rapidlyabsorbed. The pupils of both eyes acted pretty equally,and though somewhat sluggish, answered the stimulusof light. When the left eye is closed the patient endea-vours to obtain some vision on the right side by forcingthe globe of the eye towards the inner canthus; but thiseffort, though it gives him a slight perception of light,does not allow him to distinguish any object. When heattempts to walk towards a given part of the ward, with theleft eyelid held down, he takes the proper direction, but slantsgradually away from the place which he is trying to reach.Mr. Curling ordered small doses of mercury with opium, so asto bring the patient under the influence of the metal, but thismeasure had no influence on the amaurosis. Blisters on thetemple were also used, but no improvement took place. Itmay here be asked, Which part of the apparatus of vision wasaffected? Is it likely that one of the shots has found its wayto the retina, without materially injuring the conjunctiva,sclerotic, iris, or lens? This is not probable; and as for injuryto the globe, there was none. It might perhaps be surmisedthat the concussion resulting from the discharge of the gun intothe face, may have either excited inflammation in the retina,and subsequent insensibility of one determined point of thisnervous expansion; or that the same concussion deprived theretina of sensibility in all points except directly inwards,whither the patient directs the pupil, when he makes aneffort at distinguishing objects. This case brings to our recol-lection an instance of sudden amaurosis, the subject of whichwas some time ago under the care of Mr. Lawrence: we shalljust adduce a few particulars.

ST. BARTHOLOMEW’S HOSPITAL.

Sudden Amaurosis preceded by Hœmatemesis.(Under the care of Mr. LAWRENCE.)

JAMES P-, aged forty-nine years, was admitted intoHenry VIII. ward, Oct. 8, 1851, under the care of Mr.Lawrence, with complete amaurosis. The patient is a

strong, healthy-looking man, a cabinet-maker by trade; he ismarried and has several children. His habits were not veryintemperate, but he used to drink pretty large quantities ofmalt liquor up to the time of the present attack. No blow orfall on the head can be remembered, but there was at thescrobiculus cordis, about a fortnight before the loss of vision,a sense of sinking and gnawing; these symptoms did not, how-ever, prevent him from working at his trade.

After this uneasiness at the stomach had lasted about two, weeks, the patient felt, at four o’clock in the morning, when

getting up, a great depression of spirits; at six, after taking. some coffee and an aperient pill, he felt suddenly sick, and

threw up about a quarter of a pint of florid red blood. Up to

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this time, the sight had been extremely good, though it wassometimes much tried by reading. The man becamenaturally alarmed; he took some brandy and a little exercise;but at ten o’clock he threw up about the same amount ofblood, but much darker than on the previous occasion, andlooking very much like coffee-grounds. Some medicine wasnow obtained at the London Ilospital; but at four o’clock inthe afternoon of the same day, he vomited about threepints of clotted blood, which was so firm, that it looked,as he terms it, like pieces of liver. Much debility naturallyollowed this loss of blood. The patient was now attended bya surgeon, and went on for several days, throwing up now andthen a little blood, and becoming very weak. Questions werecarefully put to him, to avoid confusion between haematemesisand haemoptysis; but it remained clear that the blood was allthis time coming from the stomach.On the sixth day after the onset of these symptoms, the

patient experienced towards the evening a sensation in theleft eye, as if the setting sun were surrounded by a brilliantcircle. He went to bed, and on rising the next morning, hewas completely hlind. During the whole week which precededthis sudden amaurosis, he had had a sensation in his head asif he heard a steam-engine working noisily and regularly, thesounds being louder and more distinct when his head lay onthe pillow; but there was no actual cephalalgia, nor had therebeen any flying pains in the head.

This state of complete loss of vision lasted for about threeweeks, after which the power of distinguishing light fromdarkness was regained. The patient now sought reliefat different hospitals, among which was the OphthalmicInstitution in Moorfields. The treatment was mostly of thetonic kind; but no improvement was obtained; and whenadmitted under the care of Mr. Lawrence, the total blindnesfhad lasted eleven weeks. No vomiting of blood had occurredsince the attack of amaurosis, nor had the patient lost the usEof any of his limbs.On admission, the pupils were found motionless, the coecity 1

complete, but no visible alteration had taken place in thestructures of the eyes, which presented the usual fixity socharacteristic of amaurosis. Mr. Lawrence ordered gooddiet, steel, and blisters behind the ears. A very slight im-provement was at first noticed; the general health continuedveiy good; the man became even very stout; but no actualchange in the state of vision took place; and the patient wasdischarged six weeks after admission, in about the same con-dition as he was when first received into the hospital.This is certainly one of those cases which are calculated to

excite speculation concerning two questions: 1. What was thecause of the haematemesis1 2. Is there an immediate connexionbetween the latter symptom and the sudden amaurosis ? 1 Thevomiting of blood can hardly have been owing to an ulcerationof any kind, for neither the previous symptoms nor the sub.sequent complete cessation of the hsematemesis would warrantsuch a supposition. If, therefore, the blood came reallyfrom the stomach, we are driven to look upon thehaemorrhage within this viscus as depending on previous con-gestion, and subsequent exhalation or transudation. The un-easiness at the pit of the stomach complained of some time tbefore the attack, would tend to support the view that conges-tion, either from an abuse of stimulating fluids, or from othercauses, was the origo mali. But even conceding this point,which is far from being proved, it would still remain to bediscovered whether the loss of blood had any direct influence

on the amaurotic attack. It would certainly appear, from thesequence of the symptoms, that such has been the chain ofpathological changes. But how is it that an ansemic state ofthe encephalic mass should have acted solely on the optic tract,nerve, or on the retina ? Why were the cerebral symptoms, asusually manifested by muscular disturbance, entirely absent ?How is it that the intelligence remained perfectly unaffected ?Whence the persistence of the amaurosis ? It would perhapsbe allowable to throw out the idea that there might have beenprevious softening of certain portions of the cerebral mass,which softening had suddenly increased along a determinedset of fibres by the withdrawal of much blood. That the lossof the vital fluid, by lowering the action of the heart, and ren-dering the supply to the brain very scanty, causes swimmingof objects and indistinctness of sight, is well known; but it isequally ascertained that these symptoms quickly disappear assoon as the encephalic mass is again properly nourished; sothat the likelihood of the brain having been previously some-what affected in the case before us, gains much strength. Weshall not any further indulge in mere surmises and hypotheses,but leave our readers to give the case whatever attention theyfeel inclined to bestow.

Foreign Department.Physiological Investigations regarding the Salivary Glands

in Man and Animals.

M. CL. BERNARD very recently read a paper on this subjectbefore the Academy of Sciences of Paris; his deductions are

very important, and resumed as follows :-From the facts broughtforward in my paper it may be inferred, 1st, that anatomical ob-servation presents to us the group of salivary glands as an

homogeneous apparatus, the parts of which bear by their texturea perfect analogy to each other. 2nd, That physiologicalanalysis and experiments, on the contrary, by pointing out thediversity of the secreted fluids, and by causing the observer tonotice the nervous force which regulates the secretions, teach usthat each gland presides over one special act, and that its functionsare performed by the agency of distinct and independent influ-ences. There is no doubt that, although the different kinds ofsaliva are poured into the mouth simultaneously, their use re-mains, nevertheless, distinct; we are thus taught by experiencethat the principal function of the parotid gland is to secrete a

fluid which is to favour mastication, that of the sub-maxillarygland to secrete for gustation, and of the sub-lingual gland andbuccal follicles for deglutition.

It is only by the assistance of these physiological data that themodifications which the salivary organs undergo in the differentclasses of vertebrated animals can be studied and understoodaccording to their true meaning. The characters of salivaryglands are not to be deduced from their anatomical structure,their volume or form, but from the nature of the function withwhich they are connected. It would, therefore, be a ph3-siolo-gical error, as has been committed by some anatomists, amongwhom is J. F. Meckel, to look for parotid and sub-maxillaryglands in birds, as those organs cannot exist, since the two cor-responding functions, mastication and gustation, are generallywanting with this class of animals. It is thus evident that theuse of all the salivary glands which exist in birds shouldbe looked upon as ministering to the only function which withthem accompanies the ingestion of food-viz. deglutition. Thethick and viscous liquid which is secreted by the glandsof birds, has nothing in common with the saliva of theparotid and sub-maxillary glands, and is perfectly analo-gous to the fluid secreted by the sub-lingual gland and buccalfollicles of the mammalia. The parotid is found in its greatestdegree of development, with such of the mammalia whichhabitually chew dry and hard substances, whilst it becomesatrophied with those which live in water, and feed upon moistfood, though the other salivary glands preserve their normal

development with reference to the functions with which they are’ connected.

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The Efficacy of the Tannate of Quinine.A report was read before the Academy of Medicine of Paris on

the 17th of February, 1852, by M. BOUVIER, in the name of acommittee, composed of MM. Orfila, Bussy, and himself, touchinga paper of M. Barreswil on the therapeutic properties of tannateof quinine. The committee having instituted investigations onthe subject, have come to the conclusion-1. That the tannate ofquinine is an anti-periodic agent. 2. That it possesses, the weightbeing the same, an activity equal but not superior to that of theofficinal disulphate of quinine, for the cure of ague. 3. Thatit does not shield from relapse any more than the sulphate ofquinine. 4. That it presents hardly any bitterness, which cir-cumstance renders its administration easy, even with very deli-cate persons and children. 5. That by clinical experiments ithas been proved that the tannate of quinine acts less on theorgans of digestion, and especially on the nervous system, thanthe disulphate of quinine. 6. That whilst it bears analogy withthe Peruvian bark by its constituent principles, and with thedisulphate of quinine by the fixity of its composition, it is alsovery like these two substances by its therapeutical action. Thereporter stated finally that the tannate of quinine acts in ague asthe Peruvian bark or the disulphate of its alkaloid, and that it mayin certain cases take the place of the latter substance, though ithas the disadvantage, as an amorphous salt, of being very liableto adulteration. He also added that it should be borne in mind thatthe tannate has not been tried in pernicious intermittents. Thankswere voted to the author, and he was requested by the Academyto continue his investigations, and report their results to the Society.

THE DEAF AND DUMB.—Mr. Toynbee, F.R.S., hasrecently been elected consulting aural surgeon to the Deaf andDumb Asylum in the Old Kent-road. This is the first appoint-ment of the kind ever made, it is believed, in this country.